RESUMO
Las deformidades dentofaciales son condiciones en las cuales el esqueleto facial es significativamente diferente de lo normal, y afecta gravemente la apariencia facial, en ocasiones requiere de tratamiento quirúrgico. Se presentó una paciente de 25 años de edad, con diagnóstico de prognatismo y macrognatismo mandibular con mordida abierta esqueletal y excesivo crecimiento vertical del mentón que fue sometida a tratamiento ortodóncico quirúrgico por el Grupo Multidisciplinario de Cirugía Ortognática de la provincia Holguín y se siguió desde enero de 2010 hasta septiembre de 2012. Se aplicó terapia ortodóncica fija para corregir apiñamiento y coordinar transversalmente los arcos, se realizó cirugía de retroposición mandibular y ascenso, combinada con mentonoplastia de reducción de altura. Posteriormente, se aplicó tratamiento ortodóncico de finalización y detalles, luego se pasó a fase de contención. Se alcanzó una disminución significativa de los tejidos duros del tercio inferior, longitud mandibular y profundidad facial.
The dentofacial deformities are conditions in which the facial skeleton is significantly different from the normal one, so that facial appearance is seriously affected and requires a surgical therapy, where the patient's handling should be accomplished by a multidisciplinary team. A 25- year- old female patient, who was assisted by a multidisciplinary team of Orthognatic Surgery of Holguín province from January 2010 to September 2012 because of mandibular prognathism and macrognathism with skeletal open bite and excessive vertical growth of the chin. Fixed orthodontic treatment was performed to correct crowding and to coordinate transversally the arches, taking effect a retroposition mandibular surgery and promotion combined with a genioplasty of high reduction. Surgery orthodontic treatment on details was carried out, passing to phase of retention. Significant decrease was achieved the hard tissues of lower third facial mandibular length and depth.
RESUMO
The treatment of growing patients with Class III skeletal pattern represents one of the greatest clinical challenges for the orthodontist. Several treatment protocols have been proposed, almost all involving rapid maxillary expansion and maxillary protraction. However, there are cases where the maxilla is properly positioned in the anteroposterior direction and there is no transverse discrepancy, featuring only a mandibular prognathism. In such cases, when there is a set of favorable factors such as lack of laterognathism and lower mandibular plane angle, a viable option and which could prove quite interesting is the use of orthodontic chin cup during the night, aiming at trying to redirect the forward growth of the mandible. To have success, it is necessary that this procedure involves pubertal growth spurt and is extended to full skeletal maturation. This case was presented to the board of the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as part of the requirements to become a BBO Diplomate.
O tratamento de pacientes em crescimento com padrão esquelético de Classe III representa um dos maiores desafios clínicos para o ortodontista. Vários protocolos de tratamento têm sido propostos, quase todos envolvendo expansão rápida da maxila e protração maxilar. Porém, existem casos onde a maxila está corretamente posicionada no sentido anteroposterior e não há discrepância transversa, caracterizando apenas um prognatismo mandibular. Nesses casos, quando há um conjunto de fatores favoráveis, tais como ausência de laterognatismo e menor ângulo do plano mandibular, uma opção viável e que pode se mostrar bastante interessante é o uso noturno da mentoneira, com o objetivo de tentar redirecionar o crescimento anterior da mandíbula. Para que haja sucesso, é necessário que esse procedimento envolva o surto de crescimento da puberdade e seja estendido até a completa maturação esquelética. O presente caso clínico foi apresentado à diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO), como parte dos requisitos para a obtenção do titulo de Diplomado pelo BBO.
RESUMO
Se describen losresultados de un estudio clínico observacional sobre laserterapia en la fase postoperatoria de 26 pacientes sometidos a reducción de prognatismo mandibular con osteotomía sagital bilateral de rama ascendente (OSBMKS). Todos los procedimientos de cirugía ortognática fueron realizados de enero a diciembre de 2002, en el Servicio de Cirugía Maxilofacial del CMN SXXI del IMSS aplicando en el lado derecho de la región intervenida hasta 10 sesiones de láser diódico, siendo el izquierdo el lado control, observando mejoría en disminución del dolor y del cuadro inflamatorio agudo en relación a los pacientes a quienes no se aplicó esta terapia. Se evaluaron los resultados con medición clínica del edema postoperatorio a las 24 horas, 72 horas, 8 días, 15 días y se verificaron los cambios histológicos y radiográficos ocurridos en el proceso de cicatrización ósea a los 30 días, 6 y 8 semanas posterior a la cirugía ortognática.
This study describes the prevalence of patients with dentofacial deformities attended in the Maxillofacial Surgery Department of Hospital de Especialidades del Centro Médico Nacional Siglo XXI of the IMSS, during January to December 2002. Twenty-six patients received postoperative laser therapy in the right area of the mandible ramus, after bilateral sagittal modified osteotomy (BSMKSO). The results with laser therapy showed less pain and edema in comparison other patients without this therapy. The results were carried out after 24 hours, 3 days, 8 days and 15 days, and after 10 treatments of laser therapy. The X-Ray and biopsy showed bone healing 30 days, six and eight weeks after orthognatic surgery procedures.
